health insurance

Who and where are the 45 million Americans that the Census Bureau found without health insurance? Roughly a third of those lacking insurance earn $50,000 a year or more. The BlueCross BlueShield study notes that 1 in 3 of the uninsured are eligible for — but not enrolled in — a government-sponsored health program. Because Medicaid and children's health programs allow patients to be signed up literally in the ER, these individuals could be covered; they just choose not to do the paperwork.

And of the remaining uninsured, 6 million lack insurance for only a few months.

The bottom line: About 8.2 million Americans, not 45 million, are chronically uninsured and low-income. And they are the working poor. They have jobs but, because of the high cost of insurance, no coverage. Insurance is expensive. In an attempt to make health insurance more equitable and fair, regulation after regulation was added to the books. Many states now dictate what health insurance must cover (including pastoral counseling in Vermont), who must be covered and at what price. That millions of people lack insurance isn't surprising: Millions of Americans would lack clothes too, if governments insisted that we shop only at Saks.

What, then, to do about the uninsured? President Bush wants to give every uninsured person a tax credit for $1,000 to help with the cost of coverage. The plan offers too much help to those who don't need it and does too little for the working poor. State regulations have crippled insurance choices and driven up the cost of coverage in many jurisdictions. By shopping around, uninsured Americans could find a low-regulation (and thus low-cost) state in which to buy coverage. According to a recent study published in Health Affairs, the government spends almost $35 billion a year providing care to those lacking coverage. Because these programs primarily fund emergency care provided by hospitals rather than insurance, they end up serving hospitals' interests more than patient health.

Here's an alternative: Washington should offer states block funding (using welfare reform as a model) and allow them to experiment with coverage options. Some states would spend the money on the people who need it most: the chronically uninsured. By not focusing on the higher-income uninsured, or those eligible for government insurance, a state-created voucher program could potentially offer thousands of dollars per person for coverage — enough to buy insurance in any state in the nation.